Acceptability and implementation considerations of the patient-collected rectal swab for sexually transmitted infections testing among men who have sex with men and transgender women in Kigali, Rwanda

BackgroundRectal sexually transmitted infections (STI) are prevalent among men who have sex with men (MSM) and transgender women (TGW). Self-collection of rectal specimens is widely used globally, but limited data exist on its implementation in Africa. We report experiences of MSM/TGW self-collecting rectal STI specimens in Kigali. MethodsFrom March to August 2018, 738 MSM/TGW were recruited in a cross-sectional study using respondent-driven sampling in Kigali. We tested for Neisseria gonorrhea and Chlamydia trachomatis using the Cepheid GeneXpert CT/NG platform on self-collected rectal swabs. Likert scales assessed self-collection difficulty and comfort. Ordered logistic regression analyses were performed to characterize factors associated with self-collection difficulty. ResultsOverall, 14%(106) identified as TGW. In total, 78%(577) found rectal swab self-collection easy/very easy, while 15%(108) found it difficult/very difficult. Most, 92%(679), were comfortable/very comfortable with the test, and 98%(730) said they would repeat the test in the future. In multivariable RDS-adjusted analyses, discomfort with the swab was positively associated with difficulty in self-collection (adjusted cumulative odds ratios ((aCOR): 7.9(95%CI: 4.9-12.8)) and having a prevalent rectal STI (aCOR: 4.19, 95%CI: 2.02-8.72) was significantly associated with difficulty. Furthermore, 10%(75) of rectal swabs returned indeterminate results (65 invalid results and 10 errors). ConclusionMost MSM/TGW found self-collection of rectal swabs easy, comfortable, and collected valid samples. Self-collection of rectal swabs could be used alongside clinic- and community-based STI testing to improve diagnosis and treatment in Rwanda. However, measures to optimize sample collection and processing are needed to reduce the cost and clinical implications of indeterminate results